tbuckley/cabot-search huggingface dataset:
Elucidating the connection between pneumonia and melanoma: Risk factors and outcomes for patients with melanoma.
Authors: Henna Hundal, Kamil Taneja, Karan Patel, Alex Zhang, Michael Diaz, Nicholas Libraro, Jules A. Cohen
Journal: Journal of Clinical Oncology (2023)

e21561 Background: Pneumonia is a common cause of morbidity and mortality in patients with melanoma and leads to many ED visits per year in the US. However, there is no national-level study that has assessed factors that increase risk for melanoma patients to present to the ED with a primary diagnosis of pneumonia. Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to identify melanoma patients that presented to the emergency department (ED) with a primary diagnosis of pneumonia. A multivariate logistic regression was used to identify characteristics that were significantly associated with a higher chance of pneumonia. A p-value less than 0.05 was considered significant. Results: Between 2006 and 2012, 239,956 melanoma patients presented to the ED. Amongst these patients, 3.1% presented to the ED with a primary diagnosis of pneumonia. The majority of patients were at least 80 years old (64.3%), male (61.5%), Medicare beneficiaries (73.1%), of the highest income quartile (28.7%), living in the South (35.7%), presented to non-trauma hospitals (53.1%), and presented to metropolitan non-teaching hospitals (44.9%). Factors associated with the highest risk of pneumonia in melanoma patients are the following: Medicaid patients (odds ratio (OR): 2.5, 95% Confidence Interval (CI): 1.4-4.4, p=0.003), Medicare patients (OR: 2.3, 95% CI: 1.4-3.0, p=0.002), private insurance patients (OR: 2.1, 95% CI: 1.3-3.5, p=0.005), non-metropolitan teaching hospitals (OR: 1.6, 95% CI: 1.3-1.9, p&lt;0.001), living in the Northeast (OR: 1.3, 95% CI: 1.3-3.5, p=0.005), being male (OR: 1.3, 95% CI: 1.1-1.4,p&lt;0.001) a high Charlson Comorbidity Index (OR: 1.3, 95% CI: 1.2-1.3, p&lt;0.001). The majority of patients were either admitted (86.4%) or discharged home the same day (11.1%). Amongst the patients that were admitted, most patients were discharged (59.0%), transferred to a skilled nursing facility or intermediate care facility (19.2%), or given home health care (15.8%). Only 4.0% of admitted patients died in the hospital. Conclusions: A melanoma patient’s risk for developing pneumonia is depending on insurance status, the region of their hospital, their biological sex, and the presence of comorbidities. Clinicians should be aware of these risk factors to minimize the risk of pneumonia occurring in this at-risk population.
Busulfan, melphalan, and carfilzomib (BuMelCar) conditioning for autologous stem cell transplant (ASCT) in multiple myeloma: Phase I/II data.
Authors: Joseph Allan Norton, Patrick Hagen, Stephanie Tsai, Scott E. Smith, Mary Lee, Loredana Campo, David Oldenburg, Patrick J. Stiff
Journal: Journal of Clinical Oncology (2023)

8021 Background: Melphalan-200 high dose chemotherapy for ASCT has been the standard of care for multiple myeloma (MM) for over 30 years. Newer combination regimens such as Busulfan and Melphalan (BuMel) have demonstrated improved progression free survival (PFS) but with increased transplant related morbidity including mucositis and infections. Our group previously demonstrated that adding a proteasome inhibitor (bortezomib) to BuMel further increased PFS with mucositis ameliorated by Palifermin. Building on this effectiveness, we added carfilzomib to the BuMel backbone in a Phase I/II manner focused on safety and initial effectiveness of this novel regimen. Methods: This phase I/II open-label dose-escalation/expansion study (NCT03795597) enrolled patients with relapsed or high risk first remission MM. Patients received Busulfan over 4 days at a target total AUC of 20,000 mM-min followed by melphalan at 140mg/m2. Patients received 4 total doses of IV carfilzomib, 2 before melphalan and 2 after, with the final 2 doses escalated based on toxicity. Palifermin was given on days -11,-10, 0, and +1. Once MTD was determined, 10 more patients were treated at that level. Primary objective was safety and secondary outcomes were response to treatment at day 100 including MRD, engraftment kinetics, PFS, and OS. Results: Patients were predominantly male (79%) with median age 60.95 years. Median KPS was 80 and median HCT-CI was 2. The carfilzomib MTD was 36 mg/m2. One SAE of grade V ischemic colitis was seen at the 45 mg/m2 dose level. Toxicity at 36 mg/m2 yielded a similar pattern to our prior bortezemib containing regimen with grade 1 NSVT in 2 patients and hypertension in another. With a median follow up of 22 months, only 1 of the 13 MTD patients has progressed at 33mo. 2-year PFS and OS are both 100%. Analysis at D+100 showed 69% of MTD patients were MRD negative regardless of genetics. Conclusions: This novel BuMelCar ASCT regimen is safe and tolerable and appears to lead to a high % of MRD negative disease at D+100, which other studies correlate to a high PFS at 2 years. A comparison study with mel 200 is warranted to test whether BuMelCar can improve transplant outcomes especially in high-risk patients. Clinical trial information: NCT03795597 . [Table: see text]
Assessing the willingness to participate in future clinical trials.
Authors: Amy L. Shaver, Nikita Nikita, Joshua Banks, Christiane El Khoury, Rebecca J. Melillo, Yawei Song, Grace L. Lu-Yao, Amy Leader
Journal: Journal of Clinical Oncology (2023)

e18899 Background: Sidney Kimmel Cancer Center at Jefferson in Philadelphia, PA conducts a bi-annual survey to identify and describe their catchment area. Since patient participation is critical to the future of cancer clinical trials yet less than 6.3% of cancer patients participate nationally, the most recent survey included questions related to willingness to participate in future clinical trials. Survey items included the willingness to participate in future clinical trials and offer insight into reasons to and not to participate. Methods: A cross-sectional study was conducted among adult residents in southeastern Pennsylvania and New Jersey from July 2022 to August 2022 and included 2,744 respondents. Survey questions were included to elucidate reasons for or against willingness to participate, cancer attitudes or beliefs, health literacy, and numeracy. Characteristics were summarized with frequency counts and percentages. Frequency counts were weighted. Weights were calculated by iteratively adjusting the marginal values of select demographic characteristics to match the population totals of each surveyed county based on population totals obtained from American Community Survey data. Results: The weighted sample represented the 3,889,048 residents of the catchment area. Survey respondents self-identified as Hispanic (9.3%), non-Hispanic (NH) White (57.8%), NH Black (19.0%), and NH Other (14.0%). Only 50.8% of the population expressed willingness to participate in a future clinical trial. Over 50% of Hispanics, NH Backs, and NH Whites were willing to participate in future trials (Table). Those who did were more likely to be married (51.4%) and NH White (61.1%), see table. When asked the reason for future participation the strongest response was the possibility of learning more about my health or medical condition (67.4%). The weakest reason was similar between both my family (12.4%) and my doctor (14.2%) who would want me to participate. The strongest reason against participation is “worry about experiencing side effects” (52.6%). Conclusions: The results shed light on the need to ask catchment members when designing recruitment methods. Future endeavors involving community engagement and education may improve willingness to participate. [Table: see text]
Patient perception and adherence to lung cancer screening in those who meet eligibility criteria.
Authors: Sasmith R. Menakuru, Vijaypal S. Dhillon, Amir F. Beirat, Nasser H. Hanna
Journal: Journal of Clinical Oncology (2023)

e22503 Background: The US Preventive Services Task Force reported 14.2 million Americans qualify for lung cancer screening. As per the Lung Cancer Screening Trial, using low dose computed tomography (LDCT) for screening demonstrated a 20% reduction in lung cancer-related deaths. Despite that, the 2022 State of Lung Cancer Report from the American Lung Association indicates that only 5.8% of eligible patients in the U.S. undergo lung cancer screening. Indiana, where this study was conducted, is ranked 46/50 and 44/50 in the number of smokers and incidence of lung cancer, respectively. A statewide lung cancer screening effort is greatly needed. Methods: The study population was recruited between 10/2022 and 1/2023 from 2 hospitals within the Indiana University Health network. Patients were surveyed during their primary care clinic visits. Eligibility criteria included a 20-pack-year or more history of smoking, an age between 50 and 80, and were either current smokers or quit within the last 15 years. A survey was designed with open-ended questions and was standardized to all participants. The questions covered the cohort's familiarity with lung cancer screening, the associated risk with smoking, and the potential hindrances to getting screened. After discussing the benefits and risks of the screening, the patients were then asked if they would consider getting an initial LDCT. Patients' compliance with their scheduled LDCT date was recorded. Results: 175 persons met eligibility criteria, and all reported understanding the link between smoking and lung cancer; however, 147 (84%) were unfamiliar with the need for screening. The barriers to screening, as described by the cohort, included fear of cancer diagnosis (33.7%), lack of symptoms (22.2%), the stigma associated with being a smoker (12.6%), doubting the usefulness of screening (12.0%), not wanting to quit smoking (6.9%), cost of LDCT in those under 65 (4.6%), fear of exposure to radiation (4.0%), believing that cancer treatment would be worse than continuing to smoke (2.3%), and mistrust of the medical system (1.7%). When the patients were educated on LDCT’s benefits and risks, 118 patients (67.4%) perceived it as beneficial and elected to get it scheduled. Of the 118 patients, 64 (54.2%) attended their scheduled initial LDCT. Conclusions: The patient’s perceptions of screening varied, and from our data, it appears that most smokers were unaware of the need for a LDCT and had multiple concerns. Once the patients were educated about the benefits and risks of lung cancer screening, most scheduled an initial LDCT and perceived it to be beneficial.
Pyrotinib plus antiangiogenic agents for HER2-altered advanced non-small cell lung cancer: A retrospective real-world study.
Authors: Yaning Yang, Guangjian Yang, Yan Wang
Journal: Journal of Clinical Oncology (2023)

e21141 Background: Although some targeted therapies have been shown to be effective in treating HER2-altered non-small cell lung cancer (NSCLC), the survival demands have not yet been met due to the high cost and limited availability. This study aimed to assess the effectiveness and safety of pyrotinib plus antiangiogenic agents, including apatinib, anlotinib, and bevacizumab in previously treated patients with HER2-altered advanced NSCLC. Methods: In this retrospective real-world study, patients with HER2-altered NSCLC who received pyrotinib plus antiangiogenic agents as second or later-line treatment between November 2015 and January 2022 were reviewed. The objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and safety profiles of patients were analyzed. Results: A total of 107 patients were included in the analysis. Fifty-nine patients (55.1%) have received at least two lines of prior chemotherapy or HER2-targeted regimens. Most of them (87.9%) were identified as HER2 exon 20 insertions. At the data cutoff date (May 13, 2022), the ORR, DCR, median PFS, and median OS were 19.6% (21/107), 94.4% (101/107), 7.13 months (95% confidence interval [CI]: 6.26-8.01), and 19.50 months (95%CI: 12.83-26.17), respectively. There was no difference in the PFS between patients receiving apatinib or anlotinib/bevacizumab (median PFS, 7.13 months vs. 6.27 months, hazard ratio [HR] = 1.49, 95%CI: 0.87-2.54, P = 0.15). The most frequent grade 3 or higher treatment-related adverse events was diarrhoea (17.6%), followed by hypertension (11.0%) and nausea (3.3%). No treatment-related death occurred. Conclusions: Pyrotinib plus antiangiogenic agents demonstrated promising antitumor activity and a manageable safety profile in HER2-altered NSCLC patients.
Survival outcomes of BRCA1/BRCA2 mutated breast cancers: Study from a tertiary care cancer centre in India.
Authors: Nithin S G, Ajay Gogia, Raja Pramanik, Hari Krishna Raju Sagiraju, S.V.S. Deo, DN Sharma, Atul Batra, Akash Jha, Sandeep Mathur, Ritu Gupta, Chandra Prakash Prasad
Journal: Journal of Clinical Oncology (2023)

e22546 Background: There exists a discrepancy amongst various studies over the years on survival outcomes of BRCA (Breast cancer susceptibility gene) mutated breast cancers. Prevalence of BRCA mutation varies from 10 to 18% among Indian population and there is a paucity of data on the survival outcomes of this population. Methods: This ambispective observational study assessed the survival outcomes of 71 BRCA mutated breast cancer patients, treated with uniform protocol at AIIMS New Delhi between January 2014 to December 2022, using survival analysis and cox regression methods. Results: Amongst the 71 patients, BRCA1 and BRCA2 mutated cases were 52 (73.2%) and 19 (26.8%) respectively. The median age was 39 years (24-63 years) in both the groups. Positive family history for malignancy (BRCA1- 69.2% vs BRCA2- 36.8%) and incidence of Triple negative histology (BRCA1-82.7% VS 36.8%) were more commonly associated with BRCA1 positivity. Eight patients (11.3%) had synchronous cancer, most common being a contralateral breast primary. 4 patients (5.6%) developed metachronous cancer. Eighty percent of patients were premenopausal at presentation. There was no difference in stage at presentation, incidence of synchronous and metachronous cancers across both the groups. Of 71 patients, 18 (25%) and 17 (24%) patients underwent risk reducing mastectomy and risk reducing oophorectomy respectively. Thirty five (49.3%) presented with stage I &amp; II disease, while 28 (34.4%) and 7 (9.9%) presented with stage III and metastatic disease respectively. Forty seven patients (67.1%) received neoadjuvant chemotherapy with pathologic complete response rate of 42.5% which was uniform among both the groups. Over the study period, 10 (14.1%) patients had disease relapse with 7 (70%) being metastatic and 3 patients died of the disease. With a median follow up of 36.9 months, 3-year disease free survival (DFS) was 84.2% (BRCA1: 81.1% vs BRCA2: 93.1%) and overall survival (OS) was 94.7% for both groups. Median DFS and OS were not achieved. BRCA type, receptor status, age and menopausal status were not predictors of survival in our study. Conclusions: In our study population of BRCA1/BRCA2 mutated breast cancer, survival outcomes were comparable to historical cohorts of Indian breast cancer patients. Thus, BRCA mutation positivity doesn’t seem to have any prognostic significance in breast cancer outcome.
Cancer centers as potential knowledge hubs for emergency preparedness efforts.
Authors: Zelde Espinel, James Shultz, Vanina Pavia Aubry, Omar Munoz Abraham, Qinjin Fan, Liora Sahar, Leticia M Nogueira
Journal: Journal of Clinical Oncology (2023)

e18729 Background: Climate change is altering the frequency and behavior of extreme weather events making it harder for institutions to prepare and respond to increasingly unpredictable circumstances. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, providers, healthcare facilities, and communities before, during, and after a disaster. National Cancer Institute (NCI)-Designated Cancer Centers are at the forefront of quality cancer care and research, have greater access to resources through accreditation, and are nationally distributed, collectively acquiring a range of emergency preparedness and response experiences on a variety of disasters nationwide. This study evaluated emergency preparedness information provided in NCI-designated Cancer Centers’ websites. Methods: We systematically searched NCI-Designated Cancer Centers’ websites for the presence of information on emergency preparedness and response instructions, resources, and research efforts in September 2022. Results: Out of 71 centers, all (100%) were impacted by a climate-driven disaster between 2016 and 2020, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer, all of which included information relevant for the COVID-19 pandemic. In contrast, only 17 (23.9%) of centers’ websites provided emergency preparedness information relevant for climate-driven disasters, and only 7 (9.5%) provided information on emergency preparedness for climate-driven disaster specific for individuals diagnosed with cancer. Just one center (1.4%) mentioned ongoing research on emergency preparedness for cancer patients. None of the centers provided emergency preparedness or response information in a centralized and structured manner. Conclusions: Emergency preparedness research efforts and information sharing on NCI-Designated Cancer Centers’ websites has not kept pace with the challenges posed by climate change. Prioritizing research efforts and structured information sharing of emergency preparedness and response expertise will be crucial to ensure receipt of quality cancer care in the era of compounding disasters.
Histopathological response (HR) after neoadjuvant chemotherapy (ChT) for high-risk soft tissue sarcomas (STS): A planned analysis of the ISG-STS-1001 trial.
Authors: Sandro Pasquali, Paola Collini, Cleofe Romagosa, Jean Michel Coindre, Sara Pizzamiglio, Paolo Verderio, Marta Barisella, Emanuela Palmerini, Vittorio Quagliuolo, Javier Martin Broto, Antonio Lopez-Pousa, Giovanni Grignani, Jean-Yves Blay, Iwona A. Lugowska, Valeria Fontana, Marta Sbaraglia, Silvia Bague, Paolo De Tos, Paolo G Casali, Alessandro Gronchi
Journal: Journal of Clinical Oncology (2023)

11511 Background: HR after neoadjuvant ChT for high-risk STS has not been prospectively characterized and the prognostic implications remain unclear. This planned analysis of the ISG-STS-1001 trial, which compared neoadjuvant anthracycline plus ifosfamide (AI) and a histology-tailored (HT) ChT, was aimed at characterizing HR after neoadjuvant ChT and investigating association with the risk of recurrence. Methods: Patients registered in the ISG-STS-1001 study (ID: NCT01710176) were included if they had the per-protocol assessment of HR in surgical specimens. The following morphological post-treatment changes were considered: residual stainable tumor cells, necrosis, hemorrhage, sclerosis, sclerohyalinosis, and fibrohistiocytic reaction with haemosiderin. Pathologists at each study site analyzed and expressed each of these changes as a rate within each tumor. Disease-free survival (DFS), which was the trial primary end-point, was the outcome variable. Results: HR was assessed in 201 of 287 randomized patients (47 had re-excision, 7 did not have surgery, and 32 were not evaluable after wide excision), who were followed up for a median of 89 months (IQR 75-102 months). Presence (&gt;1%) of stainable tumor cells (N=194, 96%) was not associated with DFS (HR=1.47, 95%CI 0.36–5.98, P= 0.591). Conversely, presence (≥1%) of necrosis (N=169, 84%) was associated with shorter DFS (HR=3.11, 95%CI 1.36–7.14, P=0.007) and sclerohyalinosis &gt;20% (N=42, 21%) was associated with a lower risk of recurrence (HR=0.51, 95%CI 0.28–0.94, P=0.031). These findings were confirmed when patients who had preoperative radiotherapy (N=32) were excluded. In patients randomized to AI with tumors evaluable for HR (N=98), sclerohyalinosis &gt;20% (N=24, 24.5%) maintained the association with a lower risk of recurrence (HR=0.24, 95%CI 0.09 – 0.67, P=0.007). Finally, the prognostic value of necrosis and sclerohyalinosis for DFS held also when patients registered in the study (187/361 evaluable for HR) were selected in addition to randomized patients. Conclusions: This is the first study that prospectively evaluated HR after neoadjuvant ChT in high-risk STS. Previous classifications of HR were based on expert consensus and had limited prognostic relevance. In this study residual stainable tumor cells, which is often considered the most relevant post-treatment change, did not stratify patient risk, while sclerohyalinosis (&gt;20%) singled out patients with the best outcome after neoadjuvant ChT. Clinical trial information: NCT01710176 .
Assessing inpatient outcomes for patients with small cell lung cancer presenting with superior vena cava thrombosis.
Authors: Jay Vakil, Ekrem Turk, Ayobami Gbenga Olafimihan, Vaishali Deenadayalan, Rafaella Litvin, Khaldun Obeidat, Muhammad Bilal Ibrahim, Kunnal Batra
Journal: Journal of Clinical Oncology (2023)

8589 Background: Superior Vena Cava Syndrome (SVCS) is a condition characterized by obstruction of the SVC that can commonly be caused by thrombus formation in the SVC. Small cell lung cancer (SCLC) frequently results in obstruction of the SVC. When severe enough, SVCS can present as a life-threatening oncological emergency. In this study we aim to explore baseline characteristics of SVC thrombosis (SVCT) in patients with SCLC, the prevalence of US hospitalizations, and disparities with regards to race and socioeconomic status. Methods: National Inpatient Sample was utilized to obtain pertinent data. Total hospitalizations with coexistent comorbidities of SCLC were extracted from the 2016 to 2019 database. Adult patients with a secondary diagnosis of SVC thrombosis were determined by using ICD-10 codes. We studied the racial and socioeconomic differences as well as length of stay (LOS), total hospital charges (THC), and all-cause mortality outcomes in cancer patients with and without SVC thrombosis. Statistical analysis was performed on STATA, with logistic regression analyses and chi-square tests. Results: A total of 480,750 patients were hospitalized for SCLC. 720 of these patients had SVC thrombosis (0.15% of SCLC patients). The mean age of those with thrombi was significantly lower compared to those without thrombi (64 vs. 69, p &lt; 0.001). The SCLC with SVCT cohort had statistically higher proportion of black patients than the other cohort. Charlson index was significantly higher in SCLC with SVCT cohort (5.8 vs. 5, p &lt; 0.001). Average income between the two cohort groups were similar. Medicaid and private insurance utilization were more common in SCLC with SVCT admissions compared to without SVCT. Patients presenting with SVC thrombosis had an increased hospital LOS (10 vs. 6 days, p &lt; 0.001) and cost compared to other cohorts ($117,320 vs. $80,806, p &lt; 0.005). All-cause mortality in patients with SCLC was 7.7% and the presence of SVC thrombosis significantly increased the odds of inpatient mortality (18.0%). Non-White races were associated with higher odds of mortality in SCLC admissions. In addition, patients with SVC thrombus also had greater odds of having a concomitant pulmonary embolism during hospitalization. Conclusions: In this study we found that race, insurance type, and comorbidities impacted the likelihood of developing thrombosis in the superior vena cava in patients with SCLC. Though the incidence is rare, SVC thrombosis indicates a poor prognostic factor for patients with SCLC. Further studies to evaluate these disparities in race and socioeconomic factors are warranted. The development of thrombosis and subsequent SVC syndrome is a potentially life-threatening condition; addressing potential reversible risk factors could improve mortality in a large subgroup of hospitalizations related to SCLC.